Analysis of Intrahospital Mortality in Patients With Lung Transplant Due to Diffuse Parenchymal Lung Disease.

BACKGROUND: Patients with diffuse parenchymal lung disease (DPLD) have the poorest survival rates both before and after lung transplantation (LT). Early mortality among LT patients as a result of DLPD is estimated at 10% to 20%. The aim of the study was to assess intrahospital mortality after LT procedures for DLPD and to identify factors in the recipient, donor, intra- and postoperative periods that might improve early outcomes. METHODS: A retrospective, observational, cohort, single-hospital study was conducted. Data from 67 patients with LT patients owing to DPLD were recorded between October 2008 to June 2017 in Madrid, Spain. RESULTS: Out of 67 LT recipients with DPLD, 51 had idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), 6 nonspecific interstitial pneumonia (NSIP), and 10 other DPLD. Intrahospital mortality took place in 13.4% of patients, with a median survival time of 34 days (interquartile range [IQR], 27.50-66). In the preoperative period, there were no differences in the recipients' demographic and hemodynamic characteristics, respiratory function, or time spent in the waiting list, except higher doses of systemic steroids in nonsurvivors (prednisone 15 vs 10 mg, P = .046). No differences were reported in the donors' characteristics (age, mechanical ventilation hours, PaO2/FiO2). In the intraoperative and postoperative periods, we found differences statistically significant in longer cold ischemia time and development of primary graft dysfunction (PGD) grade 3 in the nonsurvivor group. CONCLUSIONS: The mortality rate in our series was 13.4%, and the main risk factors for intrahospital mortality were longer cold ischemia time and greater incidence of PGD grade 3.

Influence of Pulmonary Hypertension on Intrahospital Mortality in Lung Transplantation for Interstitial Lung Disease.

BACKGROUND: Pulmonary hypertension (PH) is a comorbidity associated with interstitial lung disease (ILD). The purpose of this study was to evaluate the influence of PH on intrahospital mortality in lung transplantation (LT) for ILD. METHODS: We conducted a retrospective cohort study of 66 patients who underwent LT for ILD at the 12 de Octubre University Hospital (Madrid, Spain) from October 2008 to June 2014. PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg on right-sided heart catheterization and intrahospital mortality as any death taken place after the transplantation of patients not being discharged. RESULTS: We retrospectively analyzed data of 66 patients; they were stratified by the presence or absence of PH before LT. Twenty-seven patients (41%) had PH. The PH group had a lower diffusing capacity of carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO), and 6-minute walk distance test (6MWT) and a higher total lung capacity (TLC), modified medical research council dyspnea scale (mMRC), and lung allocation score (LAS) than the non-PH group. Patients with PH more often underwent double lung transplantation (DLT; 59%) than single lung transplantation (SLT). Intrahospital mortality was 13% (9/66). No significant differences were observed in Kaplan-Meier survival curves for the PH and non-PH groups with a median survival time of 46 days versus 33 days (IQR 26-74; log-rank P = .056); however, the postoperative length of stay in the hospital was greater in the PH group. CONCLUSIONS: In our cohort, pulmonary hypertension was not related to early mortality in lung transplantation recipients for interstitial lung diseases.

Detection of Epstein-Barr virus DNAemia after lung transplantation and its potential relationship with the development of post-transplant complications.

BACKGROUND: Recent studies suggest that Epstein-Barr virus DNAemia (EBVd) may act as a surrogate marker of post-transplant immunosuppression. This hypothesis has not been tested so far in lung transplant (LT) recipients. METHODS: We included 63 patients undergoing lung transplantation at our center between October 2008 and May 2013. Whole blood EBVd was systematically assessed by real-time polymerase chain reaction assay on a quarterly basis. The occurrence of late complications (overall and opportunistic infection [OI] and chronic lung allograft dysfunction [CLAD]) was analyzed according to the detection of EBVd within the first 6 months post transplantation. RESULTS: Any EBVd was detected in 30 (47.6%) patients. Peak EBVd was higher in patients with late overall infection (2.23 vs. 1.73 log10 copies/mL; P = 0.026) and late OI (2.39 vs. 1.74 log10 copies/mL; P = 0.004). The areas under receiver operating characteristic curves for predicting both events were 0.806 and 0.871 respectively. The presence of an EBVd ≥2 log10 copies/mL during the first 6 months post transplantation was associated with a higher risk of late OI (adjusted hazard ratio [aHR] 7.92; 95% confidence interval [CI] 2.10-29.85; P = 0.002). Patients with detectable EBVd during the first 6 months also had lower CLAD-free survival (P = 0.035), although this association did not remain statistically significant in the multivariate analysis (aHR 1.26; 95% CI 0.87-5.29; P = 0.099). CONCLUSIONS: Although preliminary in nature, our results suggest that the detection of EBVd within the first 6 months after transplantation is associated with the subsequent occurrence of late OI in LT recipients.

¿Influye la experiencia del operador en la rentabilidad de la broncoscopia en el diagnóstico de lesiones pulmonares focales malignas? / Does the operator's experience influence the diagnostic profitability of the bronchoscopy in the diagnosis of malignant focal pulmonary lesions?

Introducción: La fibrobroncoscopia (FB) es una técnica de gran utilidad en el diagnóstico del nódulo pulmonar solitario (NPS) y de las masas pulmonares. La rentabilidad de la biopsia transbronquial (BTB) es variable y depende de distintos factores como la experiencia del operador. El objetivo del estudio fue determinar la rentabilidad de la BTB en el diagnóstico de la lesión pulmonar focal (LPF) maligna coincidiendo con la incorporación de dos nuevos médicos en nuestra Unidad sin experiencia previa en esta técnica, comparando los resultados con los datos previos de nuestro centro.Material y métodos: Se consideró LPF toda lesión pulmonar intraparenquimatosa bien circunscrita, rodeada de tejido pulmonar normal. Se incluyeron los pacientes remitidos desde febrero de 2008 a agosto de 2009 por una LPF (sin lesión endobronquial visible) y diagnóstico definitivo de malignidad. Se estudiaron 85 pacientes.Resultados: La rentabilidad diagnóstica de la BTB fue 0,55. La rentabilidad de la BTB fue mayor en lesiones > 2 cm (≤ 2 cm frente a > 2 cm; 0,38 frente a 0,62; p = 0,02) pero no hubo diferencias según la localización (central frente a periférica; 0,67 frente a 0,54; p = 0,16). La rentabilidad previa era de 0,76; sin diferencias según el tamaño (≤ 2 cm frente a > 2 cm; 0,72 frente a 0,78; p = 0,48), ni la localización (central frente a periférica; 0,83 frente a 0,74; p = 0,39).Conclusión: La experiencia del broncoscopista influye en la rentabilidad diagnóstica de la BTB en LPF malignas (AU)

Introduction: The fiberoptic bronchoscopy (FB) is a useful technique in the diagnosis of focal pulmonary nodules and masses. The profitability of the FB and transbronchial biopsy (TB) is variable and depends on different factors such as the operator's experience. The aim of this study was to determine if the diagnostic profitability of these techniques, in the diagnosis of malignant focal pulmonary lesions (FPL), changed with the incorporation of a new medical staff compared with previous data of our center. Material and methods: A FPL was defined as an intra ¿ parenchymatous pulmonary lesion that is well circumscribed and completely surrounded by healthy lung.We analyzed all the FBs between 02/2008 and 08/2009 in patients with a FPL with a definitive diagnosis of malignancy. 85 patients were included. Results: The diagnostic profitability of the TB was 0.55; it was higher when the FPL was > 2 cm (≤ 2 cm vs > 2 cm; 0.38 vs 0.62; p = 0.02) but no difference was found by site (central vs. peripheral; 0.67 vs 0.54; p = 0.16). The previous profitability of TB was 0.76 without differences by size (≤ 2cm vs > 2 cm; 0.72 vs 0,78; p = 0,48) or site (central vs peripheral; 0.83 vs 0.74; p = 0,39).Conclusion: We conclude that the operator's experience influences in the diagnostic profitability of the TB, in the malignant FPL (AU)

Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante / Prognosis of urinary tract infections with discordant antibiotic treatment

Introducción. Este estudio se propone evaluar el pronóstico de las infecciones del tracto urinario (ITU) tratadas empíricamente con tratamiento antibiótico inadecuado. Material y método. Estudio de cohortes prospectivo, de pacientes mayores de 18 años de edad, atendidos en un servicio de urgencias hospitalario entre el 01/02 y el 31/05 de 2007 por síntomas miccionales, acompañados de piuria (>10leucocitos/mm3 de orina no centrifugada) o tira reactiva positiva para nitritos-leucocitos y urocultivo con >103 unidades formadoras de colonias. Se consideró que el tratamiento antibiótico prescrito empíricamente era adecuado si la bacteria aislada era sensible y se había prescrito por un tiempo correcto. Se consideró que hubo fracaso terapéutico cuando persistía la sintomatología tras 5 días de tratamiento. Se registraron la edad, el sexo, la presencia de sonda vesical permanente, el tipo de ITU, hospitalización en los 3 meses previos, la procedencia del paciente y las enfermedades asociadas. Resultados. Se aislaron 177 bacterias en 168 pacientes. En 29 casos (17,3%) el microorganismo aislado era resistente al antibiótico prescrito. En tan solo 6 pacientes hubo fracaso terapéutico, aunque no precisaron ingreso hospitalario. Los pacientes que vivían en una residencia de ancianos (13,7 vs 2,2%, p=0,015) o que habían sido ingresados durante los 3 meses previos (20,6 vs 4,3%, p=0,039) presentaron un mayor riesgo de recibir tratamiento inadecuado. Conclusiones. El pronóstico de los pacientes atendidos en Servicios de Urgencias Hospitalarios por ITU con tratamiento antibiótico discordante es favorable en la mayoría de los casos. Sería recomendable la realización de urocultivo en pacientes con mayor riesgo de padecer ITU por un microorganismo resistente(AU)

Introduction. This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. Material and Methods. Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10leukocytes/mm3 of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >103 colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. Results. A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P=0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p=0.039) had a greater risk of receiving inadequate treatment. Conclusions. The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable(AU)

[Prognosis of urinary tract infections with discordant antibiotic treatment]. / Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante.

INTRODUCTION: This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. MATERIAL AND METHODS: Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10 leukocytes/mm(3) of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >10(3) colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. RESULTS: A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P = 0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p = 0.039) had a greater risk of receiving inadequate treatment. CONCLUSIONS: The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.

Experiencia de los últimos 17 años en una unidad de endoscopia respiratoria / Respiratory endoscoscopy department experience in the last 17 years

Objetivo. Describir la actividad de una de las primeras unidades de endoscopia respiratoria (UER) de nuestro país analizando las indicaciones y técnicas de broncoscopia diagnóstica y terapéutica, y si se han modificado a lo largo de los años. Material y métodos. Estudio transversal de todas las broncoscopias realizadas en nuestra UER desde 01/1992 hasta 05/2009. Para analizar la evolución de las indicaciones dividimos a la población general en cuatro poblaciones agrupadas por orden cronológico según la fecha de la exploración. Para analizar las diferencias en la frecuencia de las distintas técnicas a lo largo del tiempo empleamos el coeficiente Chi cuadrado de Pearson, aceptando como significativo un valor de p < 0,05. Resultados. 30.359 exploraciones (1.785 exploraciones/año); programadas 84,4% y urgentes 15,6%. De éstas, 26.277 (86,5%) fueron diagnósticas, 2.668 (8,8%) terapéuticas y 1.414 (4,6%) intubaciones. Se ha producido un descenso estadísticamente significativo del número de biopsias y cepillados bronquiales con un incremento significativo de las biopsias y punciones transbronquiales. Se han colocado 890 prótesis endoluminales y se han realizado tratamientos con láser en 429 casos. El porcentaje de complicaciones ha sido escaso (0,5%) y la tolerancia de los pacientes con anestesia local fue considerada buena en el 91,1% de casos. Conclusiones. El número de broncoscopias realizadas en nuestra UER es elevado, en especial las terapéuticas. Las indicaciones y técnicas realizadas se han modificado a lo largo de los años de acuerdo con la evolución de la técnica y los cambios de incidencia de diferentes patologías neumológicas (AU)

AIM. To describe the activity of one of the first Respiratory Endoscopy Departments in Spain, analyzing different techniques and indications of flexible and interventional bronchoscopy and its modifications over the years. Material and methods. Transversal study of all bronchoscopies carried out between 01/1992 and 05/2009. To analyze the different techniques along this period, the whole population was divided in four groups according to the date of the technique. The Pearson Chi square trend test was used for statistical comparisons, with p<0.05 considered to indicate a significant result. Results. 30,359 examinations (1,785 examination per year) were done; 84.4% programmed and 15.6% emergencies. For these 26,277 (86.5%) were diagnosis, 2,668 (8.8%) therapeutic and 1,414 (4.6%) intubations. There was a statistically significant decrease of bronchial biopsies and brushings and a statistically significant increase of transbronchial biopsies and punctures. 890 tracheobronchial endoprothesis were placed and 429 laser therapies were executed. Few complications were registered (0.5%) and thopic anaesthesia was well tolerated by most patients (91.1%). Conclusions. The global number of bronchoscopies done in our department is quiet large, especially therapeutic ones. Over the years, indications and different techniques have changed, according to technique evolution and different lung diseases (AU)

Estudio epidemiológico de incidencia de tuberculosis en la consulta hospitalaria de Neumología del Hospital 12 de Octubre / Epidemiologic study of tuberculosis incidence in hospital consultation of pneumology of the Hospital 12 de Octubre

Objetivo: Conocer las características clínico-epidemiológicas de los pacientes diagnosticados de tuberculosis (TBC) en la consulta externa de Neumología en el Hospital Universitario 12 de Octubre en los tres últimos años.Material y Métodos: Estudio retrospectivo de los casos nuevos de enfermedad TBC de la consulta externa de Neumología en nuestro hospital entre 01/2004 y 12/2006. Los datos se recogieron de la base de datos de codificación diagnóstica de la consulta, la revisión exhaustiva de las historias clínicas y los registros de enfermería. Elaboramos una base de datos enla que se incluyeron todos los datos demográficos, clínicos, relacionados con el diagnóstico y relacionados con el tratamiento.Resultados: Se diagnosticaron 90 casos nuevos, 61,1% varones, de enfermedad TBC. La media de edad fue de 38,6 años con el pico de mayor incidencia entre los 20 y 40 años. Un 38,9% de los casos eran inmigrantes. La edad media al diagnóstico de los inmigrantes fue 31,5 años, significativamente inferior (p = 0,02) a la de los españoles (43,1 años). El 15,6% de casos teníanalgún tipo de inmunosupresión. La forma clínica más frecuente de presentación fue la pulmonar con un 65,6% y el método diagnóstico más frecuente fue el microbiológico. La pauta de tratamiento más utilizada fue de cuatro fármacos, con 2 meses de rifampicina (R), isoniacida (H), pirazinamida (Z) y etambutol (E) y 4 meses con HR, que fue empleada en el 61,1% de los casos. En 13 pacientes se detectó alguna resistencia a fármacos de primera línea siendo la más frecuente a isoniacida (8 casos). Las complicaciones por el tratamiento ocurrieron en el 13,3% y la evolución fue hacia la curación en un91%. El registro de casos nuevos de TBC en nuestra consulta durante los años 2004, 2005 y 2006 refleja un mayor número de casos nuevos respecto a las tasas globales de la CAM y respecto a años anteriores en nuestra propia consulta.Conclusión: Se observa una mayor incidencia de enfermedad tuberculosa en la consulta externa del Hospital 12 de Octubre respecto al último registro. Este aumento de incidencia, dado el elevado porcentaje de población extranjera en los enfermos de TBC de nuestro estudio (38,9%), puede deberse a las mayores tasas de inmigración de la población del área 11 (21,3%) en relación con los datos generales de CAM (13,1%)

Objective: To know the clinical-epidemiological characteristics of patients diagnosed of tuberculosis (TBC) in Pneumology outpatient clinic in the University Hospital 12 de Octubre during the last three years.Material and methods: Retrospective study of new cases of TBC disease in the outpatient pneumology clinic in our hospital between 01/2004 and 12/2006. The data were gathered from the diagnostic coding database of the consultation, thorough review of the clinical histories and registries of the nursing department. We elaborated a database that included demographic, clinical data related with the diagnosis and with the treatment.Results: A total of 90 new cases were diagnosed, 61.1% of whom were men, of TBC disease. Mean age was 38.6 years with a greater peak incidence between 20 and 40 years. A total of 38.9% of the cases were immigrants. Mean age on diagnosis of the immigrants was 31.5 years, significantly lower (p = 0.02) than that of the Spaniards (43.1 years). Some type of immunosuppression was found in 15.6% of the cases. The most frequent clinical presentation form was pulmonary with 65.6% and the most frequent diagnostic method was microbiological. Treatment regime used most was that of four drugs, with 2 months of rifamipicin (R), isoniacid (H), pyrazinamide (Z) and etambutol (E) and 4 months of HR, which was used in 61.1% of the cases. In 13 patients, some resistance to first line drugs was detected, the most frequent being to isoniazide (8 cases). The complications due to the treatment occurred in 13.3% and course was toward cure in 91%. Recording of new cases of TBC in our consultation during the years 2004, 2005 and 2006 reflected a greater number of new cases regarding the overall rates of the Regional Community of Madrid and regarding previous years in our consultation.Conclusion: A greater incidence of tuberculosis disease is observed in the outpatient clinic of the Hospital 12 de Octubre regarding the last record. This increase in incidence, given the elevated percentage of foreign population in TBC patients of our study (38.9%), may be due to the higher rates of immigration of the area 11 population (21.3%) in relationship with the general data of the regional community of Madrid (13.1%)